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Background  Periaqueductal gray (PAG) is the descending pain modulatory center, and PAG dysfunction had been recognized in migraine. Here we propose to investigate altered PAG texture features (quantitative approach for extracting texture descriptors for images) in the patients with medication-overuse headache (MOH) based on high resolution brain structural image to understand the MOH pathogenesis.    Methods  The brain structural images were obtained from 32 normal controls (NC) and 44 MOH patients on 3.0 T MR system. PAG template was created based on the ICBM152 gray matter template, and the individual PAG segment was performed by applying the deformation field to the PAG template after structural image segment. Grey-level co-occurrence matrix (GLCM) was performed to measure the texture parameters including angular second moment (ASM), Contrast, Correlation, inverse difference moment (IDM) and Entropy.    Results  Contrast was increased in MOH patients (9.28 ± 3.11) compared with that in NC (7.94 ± 0.65) ( P  < 0.05), and other texture features showed no significant difference between MOH and NC ( P  > 0.05). The area under the ROC curve was 0.697 for Contrast in the distinction of MOH from NC, and the cut-off value of Contrast was 8.11 with sensitivity 70.5% and specificity 62.5%. The contrast was negatively with the sleep scores ( r  = -0.434,  P  = 0.003).    Conclusion  Texture Contrast could be used to identify the altered MR imaging characteristics in MOH in understanding the MOH pathogenesis, and it could also be considered as imaging biomarker in for MOH diagnosis.    Electronic supplementary material  The online version of this article (doi:10.1186/s10194-017-0727-0) contains supplementary material, which is available to authorized users.

Texture features of periaqueductal gray in the patients with medication-overuse headache